


Just Keep Breathing

by Ehann



Series: Yes Deer [3]
Category: Supernatural
Genre: Castiel is a good nurse, Gen, Graphic Description of Injuries, M/M, Nurses & Nursing
Language: English
Status: Completed
Published: 2017-12-20
Updated: 2017-12-20
Packaged: 2019-02-17 06:51:45
Rating: Teen And Up Audiences
Warnings: Creator Chose Not To Use Archive Warnings
Chapters: 1
Words: 6,757
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/13071435
Author URL: https://archiveofourown.org/users/Ehann/pseuds/Ehann
Summary: Dean's car crashes down a moutainside into Castiel's shed. Castiel's perspective on the events of 'Yes Deer'.





	Just Keep Breathing

**Author's Note:**

> Trigger warning for graphic description of injuries as well as hospital and patient issues. Medical descriptions are as accurate as possible.
> 
> Thank you for reading! This series is eating my brain and making me write more! Castiel REALLY wanted you guys to know what that week was like. :) Please leave me a comment and tell me what you think, or if you have any questions about the medical stuff.

Nov 10, 2017 

0730

No good deed goes unpunished. That should be engraved on a plaque and hung at the nurse’s station, Castiel Novak thought, while he waited to give report to the day nurse. Last night was overtime, he’d already worked his three shifts, but when the charge nurse called begging for help yesterday, going on and on about the patient acuity, and all the new nurses on the night shift, Castiel had caved and agreed to come in extra.

Thursdays were always heinous, and it carried through from one shift to another. The cardiac surgeons had a full OR of scheduled cases, the thoracic surgeons had a full slate and so did vascular. Not to mention that Thursdays were notorious for always having an emergent transplant come in. Of course, unexpected admissions happened. Someone would be at home and then WOOPS, their Aorta dissected. Or, more commonly, someone codes in the hospital, gets resuscitated and then needs an immediate ICU bed.

Castiel had been assigned a challenging patient. This guy had been at home with the flu for a week, with shortness of breath that kept getting worse and worse. He presented to the ED but coded shortly after arrival. During the code, the docs found that his heart was wildly oversized, and not pumping very well. He’d gotten cannulated for ECMO on arrival in the ICU, which was always a clusterfuck when you were trying to do compressions and the surgeons are trying to place a giant catheter into the femoral artery.

Unfortunately, the guy had kept bleeding and Castiel and the charge nurse had given almost 20 units of blood as well as a shitload of platelets, plasma and cryoprecipitate. That plus needing a dialysis catheter, a trip to both the CT scanner AND the cardiac cath lab left Castiel exhausted, physical and emotional.

He gave report to Joe, a middle-aged man with short cropped hair and a neat goatee. Joe was a longstanding ICU nurse with lots of ECMO experience so report went smoothly. On his way out of the unit, he bumped into Hannah, his fraternal twin who worked straight days as an RN in the unit. Like Castiel, she had dark hair, thick and straight, but bright blue eyes. She also looked a lot more well rested.

“Looking rough, Cas, you better get some sleep,” she smiled at him in the locker room.

Covering a yawn with his wrist he shook his thermos at her, indicating coffee in progress.

She continued, “You working this weekend?”

Castiel shook his head. “Nope, last night was overtime, and today starts my long vacation.”

“Yeah, well, you deserve it.”

“I don’t know about that,” he demurred, “but use it or lose it, so.” He smiled. “What are you doing here anyway, all dressed up.” He indicated the blouse and skirt combo she was wearing.

Hannah groaned. “Committee meetings. It’s terrible. I’ll be back here on Saturday and Sunday, so think of me when you’re sitting around in your pajamas.”

“Hey! Rude.”

“But was it untrue?” 

Cas opened his mouth, but closed it without saying anything.

Hannah winked, and said, “That’s what I thought.” She kissed him on the cheek and headed out the door to the unit. Before the door had finished closing she had stepped back in the locker room, lingering in the doorway as she called, “Don’t forget all the traffic in town tonight, Castiel, I think there’s a concert at John Paul Jones.”

“There’s no way in hell I’m coming back to town tonight. When I get up this afternoon, I’m gonna start watching Stranger Things on Netflix. People keep asking me if I’ve seen it and looking at me with this ‘oh you poor sweet old man’ expression when I tell them I haven’t.”

Hannah somehow rearranged her features so she looked kind and sympathetic. “Bless your heart…you poor sweet old man.”

“I’m leaving,” he said, chuckling. “Take care.”

“Make good choices,” his sister called cheerfully. 

 

XXX

Nov 10, 2017 

1700

Castiel shuffled across his hardwood floors, in sweats with comfy moccasins on his feet. His hair was flattened down on one side, his eyes gritty and only half open and he needed a shave. Working one night had completely fucked him up. He’d be up all hours of the night for the next few days with his luck. Didn’t matter. With five beautiful weeks of vacation he had plenty of time to relax and not think about the hospital.

2000  
Cas was not, in fact, watching Stranger Things. He’d decided to do laundry so he didn’t have to think about his dirty scrubs sitting in his hamper. Maybe later he’d open that bottle of white wine from the last winery outing a couple weekends ago. Sometimes he thought that the hospital should offer a free membership to a local wine club given how many nurses he ran into while wine tasting. The more he considered, the more he thought the white was a great idea. 

21:10

A loud crash from outside the house startled the shit out of Castiel while he was folding his clothes in the mudroom. What the fuck! It sounded like it was right out his back door.! He flipped the back light on, single bulb, not super effective, and turned back to grab the big mag-light. 

He took no more than ten paces out his back steps, and stopped, trying to understand what he was seeing. 

Maybe fifty yards away a twisted wreck of smoking metal lay half inside his shed. He could smell some combination of burning rubber and smoke. His first action should have been to call 911, but instead he ran to the car, looking to see if it was on fire or what. As he got closer he could see through the spidery cracks in the passenger window that there was someone in the driver’s seat. He went around behind the car calling, “Hey are you okay?”

_Oh my god_. The front of the car was completely crumpled, the windshield and driver’s window shattered. Cas didn’t see any air bags deployed. _What the fuck, what the fuck_.

The driver was unconscious or dead, covered in blood. There was a long laceration from his left temple straight down to his eyebrow, and a flap of skin was hanging off. Dark blood dripped steadily from this wound. Countless small nicks across his face gave his face an alien look. “Hey can you hear me?” He pointed the flashlight at the guys face and pulled his eyelids up. Both of his pupils were equal and reactive, the irises a clear green. Now that he could see in the car better, Castiel thought that his right shoulder might be dislocated. He noticed the steering column had taken some damage. He shined the light towards the guy’s feet. Hard to tell if anything broken. But he needed to stop the bleeding from his head and fast because he was losing blood at a pretty good clip and those fucking scalp lacs bled like a bitch.

Cas darted back to the mudroom and grabbed a clean towel. As he got back to the injured man, Cas saw that his eyes were fluttering. “Hey man, my name is Castiel. I’m a nurse.” The guy struggled to open his eyes. His swiped at the steady trickle of blood down his face but smeared it all over his cheek and hand. “Take it easy, buddy, you’re okay.” He folded up the towel and then pressed it HARD against the scalp wound. “Just some pressure, Buddy. You’ve got a piece of your scalp hanging off there and you’re bleeding pretty good.

Understandably, the guy did not appreciate that too much and tried to flinch away. He made a noise that sounded like a groan crossed with a whimper.

Cas could sympathize. “Yeah, I can see that.” He did not lessen his firm pressure in the least. “I know it hurts like a bitch, but no joke man, you’ve lost a lot of blood and I don’t want you to lose anymore.” The guy had on a flannel over a t shirt and from what Cas saw they were soaked through with blood on the left side.

Green Eyes managed to flutter them open in Castiel’s general direction for a moment before he said “Ugh.”

Castiel could not help the small huff of amusement. “I feel you, Buddy. I do.” He tried to see if green eyes was breathing okay. He was taking small shallow breaths, so possibly had some internal injuries. Broken ribs? Trachea was still midline so no tension pneumo. Yet. “When this slows down to a dull ooze, we should try and get you out of this car. This is kind of a dead area for cell service and it’s hard for Pegasus to get here.”

Green Eyes had his eyes open again, blinking like he was having trouble seeing.

“What’s your name, anyway,” Castiel asked him, not really expecting an answer. 

To his surprise the man eventually croaked, “…Dean.” He coughed a few times, which looked like agony. Tears leaked from the corners of his eyes. 

Castiel’s heart went out to him. He reached out and gently wiped the tears away, paying no attention to the blood getting smeared on him. “I know, Bud,” Cas said as soothingly as he could while holding pressure on a gaping head wound. “This really sucks. But we have to get you out of this car and to the hospital so you can get better. And Dean, I’m sorry to tell you this is really going to suck for you.”

Dean tried to snort, but grimaced. “Your…bedside…manner…is…awful.” He said, clearly gritting out each word. He mumbled something then tried again. “ S y’name.” His respirations were getting more and more labored with each attempt at speech.

Suddenly realizing what the injured man was trying to ask him, Cas said, “Oh, me? Castiel.” He checked the car door and found the handle. He pulled it a couple times without it budging. 

No. No this wasn’t happening. Castiel _refused_ to watch this man die because he couldn’t open a god-damned car door! A rush of heat swept through Castiel, starting at his head and sweeping instantaneously through his body. He reached out and pulled the door off the car, flinging it behind him in the grass. He leaned over and unbuckled Dean’s seatbelt.

Dean’s eyes fluttered open again. “Doctor?”

Castiel tried to figure out how to get Dean out of the car without aggravating any unknown injuries. He’d already moved his head, so if he had a high neck fracture he was pretty fucked. He finally remembered to answer the question. “Um, no actually, I’m an ICU nurse.” Maybe if he got him by the knee and spun him around on the seat? But he’d need somewhere to put him immediately. Fuck. Cas needed to get his car and fast. “I’m gonna pull my car up right here so we just have to get you in and then I can take you to the hospital.” Oh, good. A plan.

But Dean groaned, “No hospitals.”

Like he had a choice in the matter. “You’re a funny guy. Be right back.” And ran for his keys.  
It seemed to take forever to pull the car around to the back. 

He left the keys in the Escape and went back for Dean. “Okay, Dean you ready?” 

“No hospital,” Dean said.

Castiel rolled his eyes. “Uh-huh. So I’m gonna get your legs and spin you on the seat, then we’re going to stand and pivot into my car.

Dean managed to summon up an expression of disbelief. “Think my legs broken,” he said between shallow breaths. 

Cas pressed his lips together and forced himself to stay calm. This dude clearly had no idea how close he was to arresting from respiratory failure. “That means you have one leg that’s NOT broken. Or, I will pick your ass up and set it down in my car. But you ARE getting out of that car Dean and I AM taking you to a hospital.” Jesus fucking Christ, this guy. 

As threatened, Cas got hold of Dean by his shoulder and knees and spun his butt on the seat so he was facing out the door and his legs dangled over the side. With a quick glance and a wince, Cas decided that Dean was probably right about that leg being broken. Dean swayed against Castiel’s hold and went suddenly gray and pasty. Fuck. He recognized what was about to happen as Dean managed to say “Gonna puke” and then vomited all down his front, splattering Castiel with vomit below the waist.

“It’s okay Dean, you probably had low blood pressure from the loss of blood. That happens sometimes.” His head lolled forward and Cas shifted to support his weight better. Dean’s lips were quickly approaching blue territory and that was way worse than purple. “I got you. Just keep breathing, okay? Can you do that for me?” He wedged one leg between Dean’s so he wouldn’t slide out of the car while he used his shirt to wipe the emesis from around Dean’s mouth and chin.

“Ready, Dean? I’m gonna help you up, and it’s really gonna suck. You can hold on to me,” he added hopefully.

“…Can’t,” Dean murmured.

Shit fuck balls.

“It’s okay Bud.” Cas bent his knees and leaned forward at the waist, wrapping his arms around Dean’s middle “Just keep breathing,” he said, and lifted. He ignored the sound that came from Dean, he ignored the flames in his lower back, and he ignored the fact that there was No. Way. He could actually dead lift this guy into his SUV. He also ignored the fact that he somehow did it anyway.

Once Dean’s butt was perched on the edge of the passenger seat, Cas braced himself and then scooted Deans butt back. The injured man was basically crumpling at this point. He lifted Deans’ legs in the car, trying to be careful of his right leg. He leaned the seat back and pulled the seatbelt on over him. He tried dialing 911 but the call wouldn’t connect. He hadn’t been exaggerating when he’d told Dean this was a bad area for cell service.

He got in the car, and pulled it around the front and then onto the road. It was a 30 minute drive to the University hospital. Even if he called for Pegasus, it would take 5-10 minutes to get the team in the air, another 5-10 to figure out where to meet him and then another 10 back to the hospital. Castiel pressed the gas down harder. _Please God, I need your help. Please don’t let this man die._ “Just keep breathing, Dean, you’re doing great.” 

He pulled onto the highway and sped up to 80. _Please, watch over us and keep us safe._ From the corner of his eye, he saw Dean’s chest rising and falling rapidly. I never even took his pulse, Castiel thought. What is wrong with me? _Please God let me get him there in time_. He resisted the urge to panic, taking some deep breaths and letting them out slowly.

He pulled into the hospital ER thinking briefly, _that was a lot faster than I thought it was going to be._ He drove straight up into the ambulance bay, not giving a shit AT ALL, and got out, shouting, “I NEED HELP OUT HERE!”

 

XXX

22:17

Castiel had never been so happy to see a bunch of doctors and nurses in his life. His friend Gabriel, was on tonight and Cas knew he was really good, having worked with Gabe for many years as he did his residency at this hospital.

“Jesus Christ, Castiel, you trolling for your own ICU patients now? Can’t get enough of them at work?” Gabe checked Dean’s pupils (equal and reactive, 3mm), listened to his lungs, grimaced, and whipped his stethoscope back around his neck. “Not much air moving there and I hear lots of crepitation.” He nodded at the techs arriving with the stretcher. “Can you have them get two chest tube trays ready in the trauma bay? We’ll need a central line and arterial line set up, and the ultrasound. Oh, and a stat portable X ray, chest and abdomen to start. Cas, give me the bullet on this dude.”

“Found him in my backyard-(Cas had a moment to realize how ridiculous that sounded) status post MVC with rollover, restrained driver, no airbags. Unconscious when I found him, pupils were fine, in and out after that but able to answer simple questions. His head was gushing when I found him so I held pressure until the worst of it stopped. He vomited during transfer to my car, not sure if he aspirated. Right leg definitely broken towards the ankle, right shoulder dislocated or broken, not sure.” He took a deep breath. ‘His name is Dean. That’s all I know.”

 

XXX

 

Castiel had never spent much time in the family waiting lounge on the fourth floor of the hospital. He’d poked his head in as he called out looking for family and friends for various patients. Now he shifted uncomfortably on the chairs and waited with strangers for updates from the general surgeon and the trauma doctor managing Dean’s care. Gabriel had listed Castiel as the emergency contact for Dean as no one had yet come forward in person or by phone. Castiel wasn’t sure that was exactly normal protocol, but then again, he didn’t work in the ED so who really knew. He was really lucky that Gabe had been able to score some scrubs for him. Castiel hadn’t even realized his clothes were covered in blood and vomit.

He had gone down to the scanner since Dean seemed to want him there. He got agitated and upset when he couldn’t hear Cas talking to him. Castiel assumed that Dean had a concussion given the hit he’d taken to the head and his reaction to having his pupils checked, and bright lights in general. 

Sitting here now, with hours to kill, watching various people come and go from the lounge in various stages of upset, he couldn’t help but second guess his actions at the accident scene. What if Dean had drug allergies? What if he was allergic to latex? Was he on a blood thinner? Did he have a history of major surgery like Tetralogy of Fallot repair? What if—

“Mister Novak?” A tall black man in grey OR scrubs held the door open as he looked around. His ID badge read: John Williams, MD.

Castiel stood up. “Yeah, that’s me.” He extended his hand for the doctor to shake. “Castiel Novak, I’m the one that brought the MVC patient—”

‘Yeah, Mister Dean Smith,” the doctor interrupted. “He’s out of surgery now. We had to open his belly. We saw a pretty good amount of blood on the FAST exam in the ER. He had a moderate sized laceration to his liver, which took some time to repair. Fortunately, major blood vessels were intact and the minor bleeding on his spleen stopped on its own. We ran his bowel, and it was all clear. We are, however, concerned about his right lower extremity.”

Blinking, Castiel said, “I thought it was broken. Was there something more?”

Dr. Williams nodded. “There was a lot of swelling, and we lost the pulses for a short time. We left the OR and went directly to interventional radiology. The vascular surgery team was concerned about compartment syndrome. Ultimately, the IR team put in a large drain, as they felt that there was a collection of blood that was causing the elevated pressure and contributing to vascular compromise.” He added, “Ortho is following as well.”

Trying to take all this information in, Castiel ran a hand over his face. “Okay. How is he doing now though?”

“His condition is critical, but stable at the moment. He will be admitted to the ICU. He had a significant drop in blood pressure and we had to give him some blood products as well as put him on some pressors. I expect the breathing tube to stay in a couple of days at least. He’ll be at high risk for pneumonia with the broken ribs--”

“How many are broken?”

Williams pursed his lips, thinking. “Ribs three through six on the right, four and five on the left. That’s consistent with impact from the steering wheel. And, of course, his right clavicle had a disseminated fracture as well. He managed to avoid any cardiopulmonary contusions. He has bilateral chest tubes which will stay in a few days until his lungs expand better.” He waited a beat then added, “You should be able to see him in in about another hour or so. The ICU nurses will need time to get him settled.”

“Yes, I know,” Castiel said, feeling numb. “Thanks for the update, Dr Williams, I appreciate it.” He felt overwhelmed and he had understood everything the doctor had said. How much worse was this for families and friends with no medical background?

“No problem, sir, have a good night.” The physician nodded, and exited, quickly striding down the hall.

“Yeah, you too,” Castiel replied, on autopilot. He sat down, still sort of reeling from the barrage of information he’d just gotten. He pulled out his phone to check the time. It was 0240 on the 11th now. He scrolled through his contacts until he got to his friend Joe. 

To Joe P  
Are you on tonight?

From Joe P  
Sure am. What are you doing up?

To Joe P  
Brought in a stray s/p MVC  
he landed in my back yard and murdered my shed

From Joe P  
Holy shit that’s crazy. You ok?

To Joe P  
I’m in the family waiting lounge on the East side. They listed me as his emergency contact!

From Joe P  
OMG stop

To Joe P  
I did not know that was a thing.

From Joe P  
I don’t think it IS a thing. Want me to call you when he gets here?

To Joe P  
Please. I slept most of day so I’d be up anyway.

During the next hour, Castiel zoned out, exhausted. He started to notice that his back was really hurting. He would kill for some ibuprofen. He watched as a group of people straggled in, many of them looking shell-shocked and worn out. A couple of teenagers sat sullenly in the two corner chairs under the TV, busy on their phones. An elderly African American man sat next to Castiel. He had his eyes closed and his cap clenched in one hand and a Bible in the other. 

Some time later, a different physician called into the lounge, “Robinson family?” The man with the Bible stood unsteadily and Cas instinctively jumped up and reached out to prevent him from falling. 

“Thank you, son,” the elderly man said, then turned to the doctor.

Castiel took his seat again but remained on high alert. He let his eyes fix on nothing, while snatches of the conversation floated over to him. 

“…can be expected…think that…unprovoked…sign of cancer….some more tests…”

Castiel closed his eyes. The old man’s wife had an unprovoked PE, which was often a sign of undetected cancer. He suppressed a sigh and glanced over to the old man, who had his lips pressed together as his hands clutched the bible, turning his knuckles white.

“…take you back to see her…” The doctor and the elderly man left and headed to the ICU.

 

XXX

0355

A hand on his arm and a gentle shake. “Hey Cas,” Joe stood over him. “We’re ready for you.”

Castiel tried stand up but swayed. Joe grabbed him under an elbow to steady him.

“Hey man, you okay? Have you had anything to eat or drink lately?” Joe looked him over thoroughly, and Cas knew he could see the black circles and sunken eyes he was currently rocking.

Castiel said around a yawn, “Oh, I never ate dinner.”

“Come on man, I stole one of those recliners from the floor and I’ll get you some ice water.” Joe added kindly, “I can hook you up with a pillow and blanket if you’re wanting to stay.”

Castiel considered that as he walked with Joe toward the ICU. The night staff was mostly pretty young and pretty new. Lots of good kids, but also plenty of clueless new grads fresh off orientation. Mistakes happen, everyone makes them and nurses are only human. Still. He had talked to the guy. He wanted to do right by him. It had been Jesus—how many hours now? Surely someone had missed their husband or family member? Castiel was a firm believer that every patient needs an advocate at the bedside especially if they are not able to protect their own safety. “I’ll probably do that, Joe,” he said eventually, as Joe badged them into the unit.

They stopped at room 29, where the door sign read: TM Macaw JW. Oh, Castiel’s sluggish brain realized. TM meant ‘trauma male’. What was the Macaw thing about though? 

He entered the room, and everything seemed at once familiar and alien. He had seen this man, talked to him. Cas knew what color his eyes were and had held his hand on the CT table. He automatically took in the monitor readings, the vent settings, and IV infusions. Yikes. Dean was on rocket fuel, Epi, Levo and Vaso all at fairly high doses. His heart rate was in the low hundreds, sinus, and MAP was just over 60. Not fantastic. He eyed the foley bag at the end of the bed and the urimeter had over 100 ml of blue/green urine. Makes sense. He’d gotten methylene blue down in the OR. Probably for vasoplegia and shock.

Dean’s eyes were swollen closed. His whole face looked bruised and puffy. The laceration at his temple had been partially glued shut, but had staples over it, the edges purple and angry. A deep bruise rose on his left cheek. He had tiny scratches and lacerations all over his face and arms. Remembering the way he had guarded that right arm, Cas went over to the left side of the bed and oh. That’s where the recliner was. 

“Hello Dean,” Castiel said softly. “It’s Castiel. I’m the person who found you after your car accident. You’re in the hospital now. You did really good.” He picked up Dean’s hand hesitantly, then a little surer. Touch was very important for patients. Cas gently squeezed Dean’s fingers. “I hope you don’t mind,” he continued, “but I’m going to stay with you tonight. Your nurse is—” He looked to the white dry erase board and breathed a sigh of relief. “Your nurse is Meg tonight. She’s one of my friends and I know you’re in very good hands.”

He kept talking to Dean for another few minutes before stepping away. He saw that someone had left an orange armband and a patient care partner brochure on the small table by the window. Castiel looked at the arm band for a long time. A pitcher of ice water also sat on the table along with a handful of graham crackers and peanut better tubs. He smiled. He was so proud these were his people. _And this is why I love nursing_ , he thought. He sat down in the recliner. While not comfortable exactly it was certainly less terrible than a cardiac chair.

The ventilator did its job, steadily breathing in and out for Dean. Castiel slept.

XXX

As Castiel had feared, Dean got worse before he got better. On post op day 2 he developed a fever of 39 degrees, hypotension and tachycardia. The physician teams thought he had pneumonia (ventilator acquired) but cultured some of his blood and urine to make sure the infection had not seeded. They started him on broad spectrum antibiotics, Vancomycin and Zosyn (Castiel really hoped Dean didn’t have any allergies) and started trying to wake him up by lightening his sedation. Castiel had pulled the regular chair close to the bed and was reading parts of the newspaper out loud. He happened to glance over and saw Dean’s eyes were open and he was looking around.

Cas laid the paper down and stood up, saying, “Hello Dean. Can you see me?”

Dean turned his head and looked right at Castiel.

“My name is Castiel and I’m one of the nurses,” he said automatically. “Do you know where you are?”

Dean blinked furiously and shook his head minutely.

Castiel told him, “Today is November 13, and you were in a car accident a few days ago. I found you and got you out of your car and brought you to the hospital.”

Dean tried to shift in the bed, and grimaced, squeezing his eyes shut. 

“I know, buddy, you must be in a lot of pain. You’ve been through a lot. But first, can you squeeze my hand?” He put two fingers into Deans palm and the other man squeezed. Hard. “That was awesome,” Castiel smiled. “Let’s do the other side…Good! Now let me see you wiggle your toes.” The left toes moved briskly, the right ones weakly. “Dean, that was great. I need to have your nurse come look at you, ok, and I need you to keep your hands down by the bed, can you do that for me?”

Green eyes fluttered, then focused on Castiel. Dean nodded.

Castiel was unsurprised to watch Dean becoming more and more agitated as physicians came in to watch him follow commands. Finally, he said, “Guys, how many times does he need to wiggle his toes? Let the man rest, can’t you see he’s exhausted and in pain?” He may or may not have let irritation creep into his voice.

Chastened, the docs agreed that their patient was neurologically intact. After they left the room Castiel muttered, “Jesus fucking Christ.” He looked over at Dean to see the man staring right at him. He picked up Dean’s hand and squeezed briefly. “Sorry about that, I should have put it to a stop sooner.”

Dean gave him a one-sided shrug and let his head flop back against the pillows.

“You’re getting better Dean. You’re young and strong, and you’re going to be just fine. You just need a little time. Just keep breathing, you’ll be okay.”

Those green eyes peered at him again, and Dean raised his eyebrows as if to say, “ _Do you really think so_?”

Smiling, Cas said, “It’s true.”

Raising his left arm, Dean pointed at the tube in his mouth and raised his eyebrows again.

“Oh, _that _I don’t know, Dean. You’re fighting off a pretty bad lung infection, and you’ve got about six broken ribs.”__

__Dean looked like a lightbulb went off over his head. Maybe he was wondering why his chest was so sore._ _

__“I think you hit the steering wheel pretty hard.”_ _

__Dean snorted and whirled his index finger in a gesture like ‘over and over’._ _

__“Oh,” Castiel said. “I didn’t realize. The car rolled over?”_ _

__Dean nodded emphatically and then winced. He reached up to rub his head but Castiel caught his hand._ _

__“Try to keep your hands down, okay? You have a healing wound right here—” Castiel pointed to the location at his own temple. “—And it goes like this,” he continued drawing his finger from his left temple to past the corner of his left eye. “So even though you probably have a headache, you gotta try to keep your hands down.”_ _

__Dean lifted his hands in a placating gesture._ _

__“You’re very expressive,” Castiel told him, somewhat charmed._ _

__Now Dean brightened. He smiled around the endotrach tube, showing off his straight teeth._ _

__Castiel laughed. “You think you’re adorable, don’t you?”_ _

__Dean lifted his brows again and gave him a smug expression._ _

__“Well, Dean, I’m gonna go home and get some rest. I’ll be back another time to see you. Okay?”_ _

__But Dean drew his brows together, glowering. He pointed at the chair._ _

__“Well, I do have to go home,” Castiel laughed. “I’ll come back tomorrow and visit.”_ _

__Meeting his eyes firmly, Dean made an X over his heart._ _

__Cas squinted, unconsciously tilting his head. “…Oh! You mean cross my heart? Like do I promise?”_ _

__Another smug smile._ _

__“Yes, Dean. I’ll come by tomorrow to hang out with you.”_ _

__

__XXX_ _

__Nov 14 2017  
0330_ _

__

__The relentless buzzing of his cell phone dragged Castiel from a heavy sleep. Blearily looking at the number, he thumbed it open. “Yeah, this is Castiel.”_ _

__“Mister Novak? This is Dr Jaeger. You’re listed at the emergency contact for one of our patients, Dean Smith, in the ICU.”_ _

__Castiel sat up, rubbing his eyes. “What’s wrong?”_ _

__“Well, Dean chewed through his ET tube—”_ _

__“Are you kidding me?”_ _

__“Uh, no sir, I’m dead serious. He had been getting progressively more agitated as the night went on, and managed to bite through his tube. Unfortunately, he was not able to support his breathing well enough and we had to emergently reintubate and put him back down to get his oxygen back up.”_ _

__“Fuck.” Castiel said, flopping back on the bed. “How is he doing now?”_ _

__“Touch and go there for a few minutes, but once we sedated him again, his numbers started to recover. I was actually calling to get your consent to do a bronchoscopy. It’s a diagnostic test—”_ _

__Cas held up a hand to the empty room. “I know what it is, I’m an ICU nurse. If you think he needs it, go ahead and do it. I’m getting dressed and will be in shortly.”_ _

__“All right, sir, drive safe.” The call disconnected._ _

__He tossed the phone on the bed, and swung his legs over the side. He sat with his elbow on his knees and the heel of his hands in his eyes. Where the_ hell_ was Dean’s family? His accident was what, four days ago? Didn’t anybody miss him? Wasn’t anyone worried about him? Castiel was worried sick! He shook his head, irrationally furious at people he’d never met and wasn’t even sure if they existed.  
Patients got weird at night. They woke up confused and pulled at their lines and wires and tubes. No matter how dedicated a nurse is, patients need someone at the bedside to be a reassuring and stable presence. 

He pulled on clothes and grabbed his keys. He turned back at the last moment and grabbed his ID badge, then he headed out.

 

XXX

“Hey Cas,” a voice said from behind him.

Castiel turned, one hand still on Dean’s bedrail. “Hi Suzanne.” The young redheaded night nurse was taking care of Dean tonight.

“Dude thanks for coming in.”

“No problem. Can you tell me what happened?”

Suzanne’s eyes widened, and her ponytail bobbed as she spoke. “Oooh, well homeboy woke up a couple hours ago _hella_ pissed and started pulling at all his shit. We put mitts on his hands and he got even _more_ hella pissed. Started chomping on his ET tube. Respiratory went to get a bite block, but he bit it clean in half, like what the fuck, man?” She glared at the unconscious man.

“It would have been fine,” she continued, “but he was REAL MAD and was coming straight up off the bed, like, growling at us and shit, and he tanked his pressure like whoa, and his oxygen was in the toilet.” She shook her head silently. “Worse thing is you just know it was really hurting him to do all that especially with his fucked up ribs. Anyway, while we were getting ready to intubate he started coughing real bad, couldn’t clear his secretions, and vomited.”

Sighing, Castiel said, “Yeah, he does that.”

“Mmm-hmm,” Suzanne agreed.

“Did they bronch him already?” Castiel asked.

“Yeah man, the night intern was setting up the bronch cart when Jaeger called you. He hung up and was like boom boom boom, done.” Now she grinned. “You should have SEEN all the gross shit that came up outa his lungs it was—”

“Ick, no thanks.”

“Wuss,” she said affectionately.

Hey, he made no bones about the fact that secretions were disgusting. “There’s a reason why I’m a nurse and not an RT, okay?”

Suzanne said, “So is he your boyfriend or what?”

Castiel snickered. “No, um. He crashed his car into my backyard.”

Suzanne just blinked. “Holy crap so you don’t even know this guy and you’re his contact? Where’s his family!?”

“I know, right? That’s what I’ve been saying for days. How can you not miss someone whose been missing for four days?” 

“Anyway,” she continued eventually, “We turned his versed way up and added precedex.”

“He won’t remember any of this,” Castiel murmured. “That’s probably a blessing.” Louder, he added, “I’ll stay for a couple of hours Suzanne. I want to hear what the team has to say when they round.”

 

XXX

 

Nov 16 2017

0445

Standing in the doorway to Dean’s room in the ICU, Castiel covered his mouth as he yawned. The Intensivist had just completed morning rounds, outlining the plan for the day. Dean continued to make slow progress. Weaning the ventilator was taking longer than expected. The Docs wondered if aspiration pneumonitis was a factor in how slow Dean’s lungs were recovering. They’d decided to start some steroids to try and reduce the inflammation. 

The bilateral chest tubes had been discontinued yesterday as planned. Cas had breathed a sigh of relief when Dean’s lungs stayed inflated. His ribs and clavicle continued to heal. His right ankle and leg remained very swollen, and had to be constantly elevated on pillows. The skin there had turned a deep purple across his entire foot and spread a little up his calf. The Jackson-Pratt drain in his leg lay on the bed, compressed as it should be, draining only a little pink fluid now.

Castiel had the regular chair pulled up next to Dean’s left side. It was getting to be time to go home for the day. After the third or so middle of the night call, Castiel had thrown in the towel and admitted to himself that he was all in for this. He purposefully stayed with Dean overnight now, and it was definitely working out better for everyone.

The nurses didn’t have to put Dean in restraints again. Dean hadn’t chewed through any more breathing tubes, and his agitation at night had really improved. In fact, most of Dean’s improvements seemed to happen at night, a fact that Suzanne had pointed out in her cheerful way. 

“Dude, how come he only gets better when you’re here? Rude.”

Anyway, Dean seemed to do much better with familiar faces, and the nursing staff made a strong effort to keep his caregivers consistent. He also responded really well to Castiel’s voice. There had been one or two occasions in which he returned from the rest room to hear ventilator alarms going off in Dean’s room, and the man himself struggling and fighting with the ventilator, looking around all panicky.

Cas always picked up Dean’s left hand and tried to talk him through it. “Hey bud,” he smiled. “I’m Castiel, one of the nurses here. You’re in the hospital. You had a really bad car accident a few days ago and you’ve been in the ICU. You’ve been really sick but you’re getting better every day.”

And Dean held on, like Castiel was the only thing keeping him grounded. Sometimes he wondered if Dean was having nightmares as they slowly lightened the sedation. He was actually kind of worried about the plan for steroids because a lot of times they made ICU patients crazy with a capital C.

So Castiel sat next to him, holding his good hand, and just talked to him. He kept up a running commentary, explaining over and over everything that had happened and why the nurses were doing the things they did. From time to time, he’d glance over expecting to see Dean asleep, but find those green eyes peeping at him from under mostly closed lids. Those times, Dean would squeeze his hands and wiggle his toes when asked. Dean would point at the chair and make the X over his heart, while trying to keep his eyes open.

“I’m right here, Dean. I’ve got you.”

**Author's Note:**

> Epinephrine-helps the heart beat stronger and faster. Increases blood pressure.  
> Levophed- Vasoconstrictor. Increases blood pressure  
> Vasopressin-pure vasoconstrictor, increases blood pressure  
> Methylene Blue-helps reverse vasodilation in shock states. Turns urine blue-green  
> Precedex- Anti anxiety, helps when weaning sedation  
> Versed- benzodiazapine. Anti-anxiety, will induce forgetfulness  
> Shock-When oxygen supply is not sufficient to meet the body's demands  
> Bronchoscopy- Using a scope to go down in the lungs and suction out deep secretions  
> Aspiration Pneumonitis-Inflammatory state after getting stomach contents into the lungs  
> Compartment Syndrome-Inflammation and swelling increases to the point it cuts of perfusion to an area of the body  
> FAST Exam


End file.
